Using out-of-hours services: general practice or A&E?
BACKGROUND
General medical and accident and emergency (A&E) services are the two major providers of open access out-of-hours care, and there are widespread concerns about rising and non-urgent demand presented to both.


METHODS
This paper examines the differential use of these services out of hours, in an audit and research study two A&E departments and 21 practices in South London. It focuses on aspects of demand, including time of contact, age-related usage and nature of presenting complaints. Through interviews with a subsample of 82 patients who attended A&E, it also provides a more qualitative focus on differential decision making.


RESULTS
Findings show that there are differences in the way A&E and general medical services are used in terms of age-related demand and aspects of presenting complaints. Significantly more families with children aged under 10 contacted a GP, and whilst more digestive, respiratory and viral/non-specific complaints were presented to GPs, musculoskeletal problems constituted the largest category of complaints presented at the A&E departments. However, some usage relating to perceived and actual availability of services appeared to be interchangeable in terms of site-of-help seeking.


CONCLUSIONS
There is a need for a collaborative multi-method approach to respond to and influence demand.
Shipman
C
C
Department of General Practice and Primary Care, King's College School of Medicine and Dentistry, London, UK.
Longhurst
S
S
Hollenbach
F
F
Dale
J
J
D000367:Age Factors; D016009:Chi-Square Distribution; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data*